For safer healthcare - Parliament of Victoria...AHPRA on social media in 2016/17 9,501 views of our videos on YouTube, with over 12,991 minutes watched We received and responded to

Annual Report 2016/17 The Australian Health Practitioner Regulation Agency and the National Boards, reporting on the National Registration and Accreditation Scheme

Your National Scheme:

For safer healthcare

Performance summaryRegistration in 2016/17

678,938 health practitioners registered in Australia, across 14 professions

Over 21,000 more registrants than last year

68,989 new applications for registration received2,800 applications for registration refused because they did not meet suitability/eligibility requirements

157,213 students studying to be health practitioners through an approved program of study or clinical training program

97% of registrants completed an online workforce survey at renewal

5,374 health practitioners identify as Aboriginal and/or Torres Strait Islander, according to the workforce survey

70,544 domestic and international criminal history checks made

98.5% of registrants renewed and completed their registration online

AHPRA: supporting the National Boards401,242 calls were made to AHPRA’s customer service teamAverage of 1,543 phone calls each day, with up to 5,000 calls a day in peak times

92.6% of telephone enquiries were resolved at first contact

54,925 web enquiries receivedAn average of 211 web enquiries each day

82% of health practitioners responded with ‘very satisfied’ when asked to rate their interaction with our customer service team

Our 15 websites received more than 12 million visits and more than 60 million page views

599 appointments made:

5 Ministerial appointments of National Board members

87 National Board appointments of National Committees

17 Ministerial appointments of state and territory board members

490 National Board appointments for state, territory or regional committee membership

Our ‘Be safe in the knowledge’ campaign to raise public awareness of the Register of practitioners saw:150,000 unique visitors to www.ahpra.gov.au/Registration/Be-safe-in-the-knowledge

Brochures delivered to over 3,250 GP practices

1,600 postcard drops across Australia

http://www.ahpra.gov.au/Registration/Be-safe-in-the-knowledgehttp://www.ahpra.gov.au/Registration/Be-safe-in-the-knowledge

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1 2 3 4

1 Includes data provided by the Health Professional Councils Authority (HPCA) for NSW and the Office of the Health Ombudsman (OHO) for Queensland (based on available data from these entities at time of publication).

2 This refers to notifications managed by AHPRA (excludes data from the HPCA and OHO). For information on how complaints about health practitioners are lodged and managed in Australia, see page 8.

3 Notification that an entity is required to make to AHPRA under Division 2 of Part 8 of the National Law. Refer to the Glossary for more definitions.

4 For more information, see www.ahpra.gov.au/Registration/Monitoring-and-compliance/National-Restrictions-Library.

Notifications in 2016/17

10,540 practitioners had a notification raised about them nationally1

6,898 notifications were received by AHPRA about health practitioners2

13.9% increase in notifications received by AHPRA

1.6% of all registered health practitioners were the subject of a notification1

The top three reasons for a notification were:

f clinical care (42.8%) f pharmacy/medication (11.9%), and f health impairment (8.4%)

32.1% increase in mandatory notifications3

28.3% of health, performance and conduct matters resulted in regulatory action

91.3% of matters decided nationally by tribunals this year resulted in regulatory action

Immediate action was taken to restrict or suspend registration of a practitioner 320 times

AppealsOf 68 appeals that were finalised, 86% resulted in no change to the Board’s decision

The decision was amended or substituted for a new decision in 9 matters, and an appeal was withdrawn 44 times

82 appeals lodged in tribunals about Board decisions made under the National Law

Statutory offences

1,895 advertising-related complaints received 1,416 closed following investigation

368 new offence complaints received relating to title protection422 closed following investigation

15 cases of falsely claiming to be a registered health practitioner successfully prosecuted before the courts

14 new offence complaints related to restricted practices

18 closed following investigation

Compliance71 conditions or undertakings are currently listed in our National restrictions library, which are used to restrict registration to protect the public4

3,011 practitioners were monitored by AHPRA for health, performance and/or conduct during the year

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http://www.ahpra.gov.au/Registration/Monitoring-and-compliance/National-Restrictions-Library

2 AHPRA Annual Report 2016/17

About usThe Australian Health Practitioner Regulation Agency (AHPRA) is the national organisation responsible for implementing the National Registration and Accreditation Scheme (the National Scheme) across Australia.

AHPRA works in partnership with the National Boards to ensure the community has access to a safe health workforce across the 14 professions currently registered under the National Scheme. Together, we protect the public by regulating health professionals who practise in Australia. Public safety is always our number one priority. Every decision we make is guided by the Health Practitioner Regulation National Law (the National Law), as in force in each state and territory.

What does AHPRA do?AHPRA delivers five core regulatory functions:

Professional standards We provide policy advice to the National Boards regarding registration standards, codes and guidelines for practitioners.

RegistrationIn partnership with the National Boards, we ensure that only health practitioners with the skills and qualifications to provide competent and ethical care are registered to practise.

NotificationsWe manage complaints and concerns raised about the health, performance and conduct of individual health practitioners.

ComplianceWe monitor and audit practitioners to make sure they are complying with Board requirements.

AccreditationWe work with accreditation authorities and committees to ensure graduating students are suitably qualified and skilled to apply to register as a health practitioner.

How does AHPRA work to protect the public?

We support the National Boards in their primary role of protecting the public.

We support the National Boards in the development of registration standards, codes and guidelines.

We publish a national Register of practitioners so that important information about individual health practitioners is available to the public: www.ahpra.gov.au/registration/registers-of-practitioners.

We manage registration and renewal processes for local and overseas-qualified health practitioners, and manage student registration.

We manage notifications about the professional conduct, performance or health of registered health practitioners on behalf of the National Boards, except in New South Wales (NSW) where notifications are managed by health professional councils and the Health Care Complaints Commission (HCCC). In Queensland, investigations may be undertaken by the Office of the Health Ombudsman (OHO). See page 8 for more information on health regulation in Australia.

We work with health complaints entities (HCEs) to make sure the appropriate organisation deals with the community’s concerns about health practitioners.

We provide advice to the Australian Health Workforce Ministerial Council (AHWMC) about the administration of the National Scheme.

f For definitions of words and phrases in this report, refer to Common Acronyms and the Glossary (from p112).

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Who oversees AHPRA’s work?The Agency Management Committee is appointed by the AHWMC to oversee the work of AHPRA.

In 2016/17, the Agency Management Committee members were:

f Mr Michael Gorton AM (Chair) f Dr Peggy Brown f Ms Karen Crawshaw PSM f Mr Ian Smith PSM f Ms Jenny Taing f Ms Barbara Yeoh AM f Mr David Taylor (to 11/04/17) f Professor Merrilyn Walton AM (to 11/04/17) f Ms Philippa Smith AM (15/06/17–current) f Dr Susan Young (14/06/17–current)

For more information, visit www.ahpra.gov.au/About-AHPRA/Agency-Management-Committee.

Who are the National Boards?The National Boards are responsible for the regulation of 14 health professions, setting registration standards, codes, guidelines and policies that all health practitioners must meet in order to be registered.

The 14 National Boards are: f Aboriginal and Torres Strait Islander Health Practice

Board of Australia f Chinese Medicine Board of Australia f Chiropractic Board of Australia f Dental Board of Australia f Medical Board of Australia f Medical Radiation Practice Board of Australia f Nursing and Midwifery Board of Australia f Occupational Therapy Board of Australia f Optometry Board of Australia f Osteopathy Board of Australia f Pharmacy Board of Australia f Physiotherapy Board of Australia f Podiatry Board of Australia, and f Psychology Board of Australia.

National Board members are appointed by the Australian Health Workforce Ministerial Council (AHWMC). Their important work is funded by fees paid by registrants. For more information, please refer to the Corporate Governance section on page 75.

For more information on who we are and how AHPRA and the National Boards work together, please www.ahpra.gov.au/About-AHPRA.

All Board websites are accessible via AHPRA’s homepage at www.ahpra.gov.au.

Our customer service team AHPRA’s customer service team (CST) predominantly manages calls in relation to practitioners’ registration.

In 2016/17, the CST received: f up to 1,543 phone calls each working day f close to 5,000 calls a day in peak times, and f on average 211 web enquiries each day.

Our web-enquiry service level is measured in hours because it is a 24/7 service. AHPRA’s service level agreement is 48 hours. In 2016/17, the CST responded to enquiries within an average of 31.5 hours.

The CST has continued to evolve since the National Scheme began seven years ago. In 2016/17, we identified changing customer behaviours, including an increase in the use of AHPRA’s online services. We saw the need to respond to changes in the way customers interact with us, and to improve training and system support for consistency of service nationwide. We also wanted to better manage and plan for the demands put on the CST, especially during peak registration and renewal periods.

In order to implement changes to address these challenges, it made sense to consolidate the CST into one location – in the past, members of the CST worked out of multiple offices located around Australia. This year saw the planning and development of a single CST location, launching in Sydney on 1 July 2017.

AHPRA on social media in 2016/17

9,501 views of our videos on YouTube, with over 12,991 minutes watched

We received and responded to 704 enquiries via Facebook and Twitter

13,961 Facebook likes33.1% increase from last year

6,320 Twitter followers25.6% increase from last year

6,403 LinkedIn followers31.9% increase from last year

Our posts received 23,695 interactions (likes, shares and comments)

http://www.ahpra.gov.au/About-AHPRA/Agency-Management-Committeehttp://www.ahpra.gov.au/About-AHPRA/Agency-Management-Committeehttp://www.ahpra.gov.au/About-AHPRA.aspxhttp://www.ahpra.gov.au/About-AHPRA.aspxhttp://www.ahpra.gov.au

4 AHPRA Annual Report 2016/174 AHPRA Annual Report 2016/17

ContentsAbout us 2

Introduction 7

Health practitioner regulation in Australia 8

Our strategy 9

Highlights of 2016/17 10

The National Scheme in each state and territory 13

National Board reports 14

Aboriginal and Torres Strait Islander Health Practice Board of Australia 15

Chinese Medicine Board of Australia 16

Chiropractic Board of Australia 17

Dental Board of Australia 18

Medical Board of Australia 19

Medical Radiation Practice Board of Australia 21

Nursing and Midwifery Board of Australia 22

Occupational Therapy Board of Australia 24

Optometry Board of Australia 25

Osteopathy Board of Australia 26

Pharmacy Board of Australia 27

Physiotherapy Board of Australia 28

Podiatry Board of Australia 29

Psychology Board of Australia 30

Accreditation 31

Accreditation and the National Scheme 32

Developing accreditation standards 32

Accreditation Committees 33

Applications for accreditation 33

A risk-based approach to monitoring approved programs 33

Approved programs of study 33

Policy, process and systems 33

Cross-profession policy 34

Future accreditation activities 34

Registration of health practitioners in 2016/17 35

Registered practitioners 36

The Aboriginal and Torres Strait Islander health workforce in 2016/17 37

Student registration 38

New applications for registration 38

Outcomes for applications finalised 39

Examinations 39

Criminal history checks 40

The Register of practitioners 40

Renewing registration in 2016/17 41

Practitioner audits 42

Notifications: complaints or concerns about health practitioners in 2016/17 43

An important note about our data 45

What is a notification? 45

How we manage complaints 46

Improving the notifier and practitioner experience 46

Notifications received in 2016/17 47

Mandatory notifications 50

Immediate action 52

Investigations 53

Outcomes and timeliness of notifications closed 54

Legal services 58

Tribunals 58

Panels 58

Appeals against decisions made under the National Law 58

Statutory offences 61

Compliance 66

How AHPRA monitors compliance 66

The National restrictions library 67

Sharing knowledge about restrictions 67

Advertising compliance and enforcement 67

Improving access to Medicare data 67

Boards governance and secretariat 69

Communication and engagement 70

Strategy and research 72

Multi-profession policy 74

Corporate governance 75

Financial management 75

AHPRA’s organisational structure and resources 76

Enterprise agreement 77

Statutory appointments 77

Getting value from our data 77

Data access and research 77

Practitioner information and exchange program 77

Corporate legal services 77

Administrative complaints 78

Freedom of information 79

Information governance 79

How AHPRA manages its activities and risks 79

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Cont

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Financial statements for the year ended 30 June 2017 81

Agency Management Committee’s report 82

Independent Auditor’s report 83

Financial statements

Statement of comprehensive income 85

Statement of financial position 86

Statement of changes in equity 87

Statement of cash flows 87

Note A: Agency financial performance 88

A1: Registration fee income

A2: Interest income

A3: Other income

A4: Expenses from transactions

A5: Events occurring after the balance sheet date

Note B: Operating assets and liabilities 91

B1: Reconciliation of net result for the year to operating cash flows

B2: Receivables

B3: Payables and accruals

B4: Plant and equipment

B5: Intangible assets and amortisation

B6: Contingent assets and liabilities

Note C: Equity, investment and commitments 94

C1: Cash and cash equivalents

C2: Investments

C3: Equity by board

C4: Leased assets and liabilities

C5: Commitments

Note D: Employee benefits 96

D1: Employee benefits and on-costs

D2: Accountable officer and executive director remuneration

D3: Superannuation

Note E: Other 98

E1: Summary of significant accounting policies

E2: Financial instruments

E3: Related party disclosures

E4: Remuneration of external auditor

E5: Co-regulatory jurisdictions

Appendices 107

Appendix 1: Structure of the National Boards 107

Appendix 2: Meetings of Boards and Committees in 2016/17 108

Appendix 3: Attendance at meetings of the Agency Management Committee and its subcommittees 109

Appendix 4: National Board consultations in 2016/17 109

Appendix 5: Approved registration standards, codes and guidelines 110

Common acronyms 112

Glossary 113

Index 116

TablesTable 1: National Board funding contributions to accreditation 32

Table 2: Accreditation programs in 2016/17 33

Table 3: Registered practitioners, by profession and principal place of practice, as at 30 June 2017 36

Table 4: Health practitioners who identified as being Aboriginal and/or Torres Strait Islander in 2016/17 37

Table 5: Student registration numbers in 2016/17 38

Table 6: Applications finalised in 2016/17 by profession and outcome 39

Table 7: Domestic and international criminal history checks, and disclosable court outcomes 40

Table 8: Proportion of practitioners who renewed their registration online 41

Table 9: Notifications received in 2016/17 by profession and state or territory 47

Table 10: Percentage of all registered health practitioners with notifications made about them in 2016/17, by profession and state or territory 48

Table 11: Individual practitioners with notifications made about them in 2016/17, by profession and state or territory 48

Table 12: Student notifications received (mandatory and voluntary) by AHPRA in 2016/17 49

Table 13: Outcomes of notifications (mandatory/voluntary) against students by stage at closure 49

Table 14: Mandatory notifications received by profession and state or territory 50

Table 15: Outcomes of mandatory notifications closed, by profession 51

Table 16: Grounds for mandatory notification by profession (including HPCA) in 2016/17 52

Table 17: Immediate action taken to protect the public 52

(Continued on next page)

6 AHPRA Annual Report 2016/176 AHPRA Annual Report 2016/17

Table 18: Immediate action cases 53

Table 19: Timeframes for matters in assessment 54

Table 20: Notifications closed in 2016/17 by profession, stage at closure 55

Table 21: Notifications closed in 2016/17, by outcome (AHPRA) 55

Table 22: Notifications closed in 2016/17, by outcome (HPCA) 56

Table 23: Open notifications at 30 June 2017 by profession and state and territory 57

Table 24: Open notifications managed by AHPRA as at 30 June 2017, by length of time at each stage 57

Table 25: Appeals lodged in 2016/17 by profession and jurisdiction 59

Table 26: Nature of decisions appealed where the appeal was finalised through consent orders or a contested hearing by jurisdiction 60

Table 27: Statutory offence complaints received and closed, by type of offence and profession 63

Table 28: Completed prosecutions as at 30 June 2017 64

Table 29: Current prosecutions as at 30 June 2017 65

Table 30: Active monitoring cases at 30 June 2017 by state or territory (including HPCA) 68

Table 31: Active monitoring cases at 30 June 2017 by profession and stream 68

Table 32: Income type 2016/17 75

Table 33: National Board registration fees for each profession 75

Table 34: Full-time equivalent resourcing as at 30 June 2017 76

Table 35: Data access requests by type in 2016/17 77

Table 36: Nature of administrative complaints by profession in 2016/17 78

Table 37: Finalised freedom of information applications in 2016/17 79

FiguresFigure 1: Who’s who in the National Scheme 8

Figure 2: Percentage of practitioners with a principal place of practice in each state and territory 13

Figure 3: Registration numbers, year by year, since the National Scheme began 36

Figure 4: Audit outcomes for 2016/17 42

Figure 5: Total notifications received, year by year, since the National Scheme began 44

Figure 6: How AHPRA and the National Boards manage complaints about health practitioners 44

Figure 7: Who makes a complaint? 45

Figure 8: The most common types of complaint in 2016/17 46

Figure 9: The notifications process 46

Figure 10: Closed notifications by average time taken to complete the matter 54

Figure 11: Closed notification outcomes 54

Figure 12: National Board matters decided by tribunals in 2016/17 58

Figure 13: National Board matters decided by panels in 2016/17 58

Figure 14: Appeals managed by AHPRA in 2016/17 59

Figure 15: Appeals finalised by AHPRA in 2016/17 59

Figure 16: Offence complaints received in 2016/17 62

Figure 17: Offence complaints open at 30 June 2017 62

Figure 18: Prosecution outcomes in 2016/17 63

Figure 19: Strategy implementation map 73

Figure 20: Our organisational structure 76

7

Introduction This year, the number of registered health practitioners in the National Registration and Accreditation Scheme (the National Scheme) increased to almost 680,000.

AHPRA works in close partnership with 14 National Boards. Jointly, we strive to keep the community safe by regulating health practitioners efficiently and effectively to facilitate access to safer healthcare. The strong commitment of both board members and AHPRA staff to this mission is a real strength of the National Scheme.

All registered practitioners must meet national standards, codes and guidelines established by National Boards. Practitioners must be ethical and trustworthy, and put their patients’ best interests first.

Practitioners renew their registration annually and must declare they meet the requirements of registration. This not only instils confidence in registered health practitioners, it also allows for workforce mobility as practitioners are registered nationally.

Each year, around 20,000 new applicants become registered health practitioners. With the introduction of paramedicine to the National Scheme in late 2018, we expect the number of registered health practitioners will soon exceed 700,000.

Members of the public who receive healthcare from one of the 14 regulated professions can be safe in the knowledge that their practitioner must meet national standards. They can search the national, online Register of practitioners when choosing a practitioner to find information about them, including any specific requirements associated with their registration. Working with our Community Reference Group, an important focus of the past year has been improving community awareness of both the register and the National Scheme more widely.

This year, AHPRA received more notifications than ever before and we worked with National Boards to respond to these notifications in a timely manner.

The growth in the number of notifications demonstrates increasing community and practitioner awareness of our work. However, growing demand also presents us with the challenge of how we deliver good regulatory outcomes while improving timeliness and the experience of both notifiers and practitioners.

Over the past year, we’ve invited feedback from both notifiers and practitioners and we’ll continue to use this information to improve the way we implement and communicate our processes for managing notifications.

The National Scheme has a strong multi-profession focus. During the year, National Boards collaborated on a range of multi-profession policy initiatives, including a strategy to support improved compliance with advertising requirements under the National Law. National Boards also collaborated on key accreditation policy issues, and made a joint submission to a discussion paper from the Accreditation Systems Review (a major review of accreditation in the National Scheme commissioned by Health Ministers).

As part of our strategy to ensure every Australian has access to safe and reliable healthcare, we have established a strategy group to guide our work on Aboriginal and Torres Strait Islander peoples’ health. This work will look at how the National Scheme, in partnership with Aboriginal and Torres Strait Islander health experts and organisations, can contribute to better health outcomes for Indigenous people.

AHPRA and the National Boards welcome feedback from the community and professions, and commit to ongoing scrutiny of our processes to ensure timely and effective handling of regulatory matters in the public interest.

Mr Martin Fletcher

Chief Executive Officer, AHPRA

Mr Michael Gorton AM

Chair, Agency Management Committee, AHPRA

Dr Joanna Flynn AM

Chair, Forum of National Registration and Accreditation Scheme Chairs

Chair, Medical Board of Australia

Intr

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Health practitioner regulation in AustraliaThe National Law provides a regulatory framework for the accreditation and registration of health practitioners. While this law is nationally consistent, two states have adopted a co-regulatory approach. So, where does AHPRA fit in?

AHPRA and the National Boards work within a dynamic regulatory environment. We are responsible for the registration of every practitioner practising in the 14 regulated health professions across Australia. However, the regulation of these practitioners is a shared responsibility.

If someone wants to make a complaint or raise a concern about a registered health practitioner in most states and territories in Australia, they can visit our complaints portal at www.ahpra.gov.au/Notifications. However, if their complaint is about a registered health practitioner or student in New South Wales (NSW) or Queensland, the process is as follows:

New South Wales The National Boards and AHPRA do not manage notifications that arise in NSW.

Fourteen health professional councils – supported by the Health Professional Councils Authority (HPCA) and the Health Care Complaints Commission (HCCC) – work together to assess and manage complaints about practitioners’ conduct, health and performance in NSW.

The National Boards have no role in handling notifications in NSW. AHPRA has a limited role in accepting mandatory notifications and referring them to the HCCC.

AHPRA ensures that all NSW notifications and their outcomes are recorded in the national database to ensure the national registers are accurate and complete.

For more information about the notifications process in NSW, visit the HPCA website at www.hpca.nsw.gov.au or the HCCC website at www.hccc.nsw.gov.au.

QueenslandThe National Boards and AHPRA only manage complaints that arise in Queensland if the Office of the Health Ombudsman (OHO) refers the complaints to us.

The OHO receives all complaints that arise in Queensland. It may refer a complaint to AHPRA and the National Boards if the OHO is satisfied that the complaint is not serious.

For more information about the notifications process in Queensland, visit the OHO website: www.oho.qld.gov.au.

Other health-complaint organisations Under the National Law, AHPRA and the National Boards work with health complaints entities (HCEs) in each state and territory to decide which organisation should take responsibility for and manage a complaint or concern raised about a registered health practitioner. HCEs handle complaints about health service providers that AHPRA and National Boards do not regulate, and can provide outcomes that AHPRA and the National Boards cannot, such as:

f an apology or explanation f access to your health records f compensation or a refund, and/or f an improvement for a hospital, clinic, pharmacy or

community health service.

Following is a list of HCEs in each state and territory: f Australian Capital Territory ACT Human Rights

Commission f New South Wales Health Care Complaints

Commission f Northern Territory Health and Community Services

Complaints Commission f Queensland Office of the Health Ombudsman f South Australia Health and Community Services

Complaints Commission f Tasmania Health Complaints Commissioner f Victoria Health Complaints Commissioner, and f Western Australia Health and Disability Services

Complaints Office.

Anyone needing advice on how to make a complaint can call AHPRA’s Customer Service Team on 1300 419 495.

Figure 1: Who’s who in the National Scheme

National Health Practitioner Ombudsman Privacy

Commissioner

Agency Management Committee

Australian Health Workforce Ministerial Council

National Boards

State/territory/regional boards

AHPRA

Accreditation authorities

http://www.ahpra.gov.au/Notificationshttp://www.hpca.nsw.gov.auhttp://www.hccc.nsw.gov.auhttp://www.oho.qld.gov.au

9

Our strategyAHPRA and the National Boards are working to a five-year corporate strategy: The National Registration and Accreditation Scheme Strategy 2015–20. The information contained in this report shows how we are performing in relation to our statutory obligations, as well as how we are tracking against our strategy.

Our missionTo protect the public by regulating health practitioners efficiently and effectively to facilitate access to safer healthcare.

Our visionTo be recognised as a leading risk-based regulator that enables a competent and flexible health workforce to meet the community’s current and future health needs.

Strategic outcomes by 2020 f Reduce risk of harm to the public associated with the

practice of regulated health professions. f Ensure that only health practitioners who are suitably

trained and qualified to practise in a competent and ethical manner are registered.

f Increase public confidence in the effective and efficient regulation of health practitioners.

f Increase public benefit from our data for practitioner regulation, health workforce planning and research.

f Improve access to healthcare through our contribution to a more sustainable health workforce.

Refining our strategy for the futureIn July 2016, work began on a new strategic planning and management framework to help us implement our strategy with a simplified and improved process (see page 73).

This framework uses a balanced scorecard approach to make it easier for us to measure our performance and track progress against our strategic objectives.

Our regulatory principlesEight Regulatory principles underpin our work, and guide our decision-making in the public interest. These principles foster a responsive, risk-based approach to regulation. They are as follows:

Protect the public

Take timely and necessary action

Administer the National Law

Ensure registrants are qualified

Work with stakeholders

Uphold professional standards

Identify and respond to risk

Use appropriate regulatory force

Read more about our Regulatory principles at www.ahpra.gov.au/About-AHPRA/Regulatory-principles.

For more information about our strategy, visit www.ahpra.gov.au/About-AHPRA/What-We-Do/NRAS-Strategy-2015-2020.

Our

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Highlights of 2016/17Working together to ensure Aboriginal and Torres Strait Islander patient safetyAHPRA and the National Boards are committed to developing an Australia-wide Aboriginal and Torres Strait Islander health strategy for the National Scheme.

A key priority of 2016/17 was establishing a strategy group to lead this important work. A strategy group was formed in February 2017 and consists of Aboriginal and Torres Strait Islander health sector leaders and representatives from accreditation entities, National Boards, AHPRA and the Chair of AHPRA’s Agency Management Committee.

We are grateful for our partners’ commitment to the shared vision of patient safety for Aboriginal and Torres Strait Islander peoples in Australia’s health system as the norm, as defined by Aboriginal and Torres Strait Islander peoples.

The initial stages of the strategy will involve three major areas for action:

f developing a strategy to incorporate training within the National Scheme on culturally safe health care

f developing an overall strategy to promote participation and retention of Aboriginal and Torres Strait Islander peoples across all registered health professions, and

f developing a reconciliation action plan that will provide a framework for AHPRA and the National Boards to build relationships with, and respect and opportunities for, Aboriginal and Torres Strait Islander communities throughout Australia.

Find out more about this work and read the advisory group’s communiqués at www.ahpra.gov.au/About-AHPRA/Advisory-groups/ATSI-Health-Strategy-Advisory-Group.

Focusing on practitioner health In the past year, the two largest National Boards – the Medical Board of Australia (MBA) and the Nursing and Midwifery Board of Australia (NMBA) – funded and developed support services for their respective healthcare workforce. The drs4drs services and Nurse & Midwife Support provide resources to support practitioners’ physical and mental wellbeing.

Ensuring the health workforce has the support it needs is an important step in ensuring the public is provided with safe and competent healthcare. For more information on these initiatives, see the MBA’s year in review on page 19 and the NMBA’s year in review on page 22.

Improving the practitioner experienceA priority for AHPRA and the National Boards this year was to make the registration process quicker and easier for practitioners. We also continue to seek to understand and improve the experience of both notifiers and practitioners involved in the notifications process under the National Law.

In 2017, AHPRA began collecting data from notifiers and practitioners in the form of surveys and in-depth interviews. Initial responses showed that notifiers find it easy to locate and use our new online complaints portal. They also appreciate phone contact with us, as well as having a consistent case manager whenever possible. Some concerns were expressed about the involvement of notifiers in the notifications process and its transparency and timeliness.

Practitioner feedback highlighted satisfaction with initial communication, their opportunity to respond, the outcome of notifications and the content of letters explaining the reasons for decisions. They also highlighted areas for improvement – as with notifier feedback, practitioners said there could be greater transparency and improved timeliness.

For more information on the Notifications process, see page 46 or go to www.ahpra.gov.au/notifications.

Enforcing the National LawThis year, a tougher stance was taken on those who do not comply with the National Law.

In February 2017, a landmark ruling saw a chiropractor convicted on criminal charges after he claimed to be able to prevent, treat and cure cancer in his advertising.

In April 2017, AHPRA successfully prosecuted a NSW man for knowingly and recklessly holding out as a medical practitioner by claiming to be a UK-based doctor. He received a criminal conviction and was fined $30,000 plus legal costs to AHPRA amounting to $22,000.

At its meeting of 24 March 2017, the Council of Australian Governments (COAG) Health Council discussed the adequacy of penalties under the National Law for individuals holding themselves out as health practitioners when they are not registered. Health Ministers agreed to consult on stronger penalties and increased prohibition powers, under the National Law.

http://www.ahpra.gov.au/About-AHPRA/Advisory-groups/ATSI-Health-Strategy-Advisory-Grouphttp://www.ahpra.gov.au/About-AHPRA/Advisory-groups/ATSI-Health-Strategy-Advisory-Grouphttp://www.ahpra.gov.au/About-AHPRA/Advisory-groups/ATSI-Health-Strategy-Advisory-Grouphttp://www.ahpra.gov.au/notifications.aspx

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Commitment to thorough investigationsAHPRA and the National Boards’ commitment to protecting the public means that we take the investigation of complaints and concerns seriously. In the most complex of cases, dedicated investigations teams work tirelessly to get all the facts in establishing whether a registered health practitioner poses a risk to the public.

A National Board may decide to investigate a registered practitioner or student if it is concerned about potential risk to patients or the public because of a practitioner’s health or welfare, how the practitioner behaves or how the practitioner is treating patients.

To find out more about our investigations process, refer to www.ahpra.gov.au/Notifications/Find-out-about-the-complaints-process/Investigation.

Timeliness is also a priority in managing notifications. While this year saw an unprecedented amount of complaints and concerns lodged with AHPRA, we worked hard to close more notifications in the year than ever before.

For more information, see page 44.

Holding ourselves accountable Like our international counterparts, AHPRA and the National Boards continue to face external scrutiny of our regulatory decision-making and performance. We are committed to ensuring greater accountability and transparency of our work by:

f publishing quarterly reports on our performance in each state and territory

f providing regular updates on our progress against recommendations by parliamentary enquiries, and

f making submissions to parliamentary reviews.

This year, we continued to embed the recommendations of the 2014 independent review of the National Scheme, including preparing for the proposed amendments to the National Law, providing a joint submission to the accreditation systems review, and commissioning research into vexatious complaints.

In August 2016, AHPRA and the Medical Board of Australia (MBA) commissioned an independent review on the use of chaperoning restrictions as an interim measure for practitioners facing allegations of sexual misconduct. The review was handed down in April 2017, and AHPRA and the MBA accepted all the recommendations.

We also provided a submission to the Queensland Parliamentary Committee’s inquiry into the performance of the Queensland Office of the Health Ombudsman’s (OHO) functions, outlining our recommendations to ensure our regulatory expertise and that of the OHO as an ombudsman and health complaints authority is applied in the best possible way to protect the Queensland public.

Simplifying the notifications processImproving the notifications experience for practitioners and the public remains a priority for AHPRA and the National Boards. During public consultations on the notifications process, it was identified that the term ‘notification’ is not commonly understood by the broader community. In response to this, we simplified our online content, with the phrase ‘complaint or concern’ replacing the word ‘notification’ across the website.

In January 2017, an online portal was launched on the AHPRA website to simplify the process involved in making a complaint or raising a concern about a health practitioner or student. An online form now guides each user through the process, including instructions on how to provide information that will best enable efficient assessment of their concern. After making a complaint, an automated correspondence is issued to the user with a copy of their complaint or concern and advice that they will be contacted by a member of the AHPRA team within four days.

The portal also contains information about the way AHPRA manages complaints and concerns, which is aimed at those who make the complaint and those who have had a complaint made about them. This includes information to help ensure the user understands the types of complaints or concerns that AHPRA can deal with and where to go if their complaint cannot be managed by AHPRA. We have also included a short online survey to ensure the online portal is meeting the needs of our users.

The complaints portal is among the first in a range of digital initiatives being developed and implemented to improve the efficiency of processes across the National Scheme.

The complaints portal can be found at www.ahpra.gov.au/Notifications/Make-a-complaint.

For more information about notifications, see page 44.

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Embedding a multi-profession approach to regulationDuring the year, the National Boards have collaborated on a range of multi-profession initiatives to progress nationally consistent approaches to regulation, supported by a policy team working with the Boards and working groups across AHPRA.

Key projects included the development and implementation of a strategy to support improved compliance with advertising requirements under the National Law; the early stages of a review of the Code of conduct shared by seven National Boards and used by an additional four (with some profession-specific modifications); and coordinating a review of core registration standards for a number of National Boards.

These initiatives are paralleled by multi-professional initiatives in regulatory decision-making. In December 2016, a Multi-Profession Immediate Action Committee (MPIAC) was formed, consisting of three community members and practitioner members from nine participating boards (Aboriginal and Torres Strait Islander Health Practitioner, Chinese Medicine, Chiropractic, Medical Radiation Practice, Occupational Therapy, Optometry, Osteopathy, Physiotherapy and Podiatry). It is intended that the MPIAC will build expertise in these areas to be a more effective decision-making body.

Engaging with international regulatory partners In September 2016, AHPRA and the Medical Board of Australia co-hosted the 12th International Conference on Medical Regulation and the International Association of Medical Regulatory Authorities (IAMRA). The event took place in Melbourne over four days and attracted more than 490 delegates from more than 40 countries. International and Australian speakers discussed and workshopped IAMRA’s theme for the year: Medical Regulation – Making a Difference.

AHPRA presented three sessions at the CLEAR 2016 Annual Education Conference, in conjunction with the Nursing and Midwifery Board of Australia. The Council on Licensure, Enforcement and Regulation (CLEAR) is an association of individuals, agencies and organisations that comprise the international community of professional and occupational regulation. The conference was attended by more than 600 members from across North America, Europe, Australia and New Zealand.

AHPRA is set to host CLEAR’s International Congress on Professional and Occupational Regulation in Melbourne in November 2017. For more information, visit www.clearhq.org/icpor.

National Boards also had a presence at a number of international regulatory meetings within their profession.

Listening to community feedbackIn 2013, AHPRA established a Community Reference Group (CRG), made up of 10 community members and a Chair, who give feedback on AHPRA’s regulatory operations and other relevant issues from the perspective of members of the general public.

Over the past year, the CRG cemented itself as a trusted source of advice and a community perspective on health regulation. Members of the group provided detailed feedback to AHPRA and the National Boards on such works as improvements to our notifications (complaints) process and the new complaints portal. They also advised on consultations on revalidation, codes of conduct for nurses and midwives, and the Occupational Therapy Board of Australia’s review of competency standards. Members also provided a community perspective at National Board workshops and events – including for the Medical, Chiropractic and Dental Boards.

The CRG is not only called upon to give advice to AHPRA and the Boards. In 2016/17, members of the group were also asked to provide feedback on a senate inquiry into the complaints mechanism administered under the National Law, and the Independent review of the use of chaperones to protect patients in Australia.

For information on the activities of the CRG and other reference groups, such as the Professions Reference Group (PRG), who advise AHPRA and the Boards, visit www.ahpra.gov.au/about-ahpra/advisory-groups.

Adding paramedicine to the National SchemeOn 24 March 2017, Health Ministers met as the Australian Health Workforce Ministerial Council (AHWMC) to consider an amendment to the National Law that will see the regulation of paramedics under the National Scheme.

If passed, paramedics will be able to register nationally for the first time in Australia, the title ‘paramedic’ will be protected nationally, and paramedicine will become a registered health profession.

AHPRA has been tasked with implementing the decision of the Ministers and, to that end, the first call for applications to the Paramedicine Board of Australia was advertised in April 2017. If the amendment bill is passed, Health Ministers will make appointments in September 2017 and the national regulation of paramedics is expected to start in the second half of 2018.

For more information, visit www.ahpra.gov.au/Registration/Regulation-of-paramedics.

http://www.clearhq.org/icporhttp://www.ahpra.gov.au/about-ahpra/advisory-groupshttp://www.ahpra.gov.au/Registration/Regulation-of-paramedicshttp://www.ahpra.gov.au/Registration/Regulation-of-paramedics

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The National Scheme in each state and territoryThe National Scheme operates Australia-wide and is a vitally important part of the Australian health system. It is governed by a nationally consistent law passed by each state and territory parliament – the National Law. There is oversight by a Ministerial Council made up of all Australia’s Health Ministers.

1 Practitioners with no principal place of practice (includes overseas registrants): 2.6% of total practitioners or 17,591 registrants.

The National Scheme facilitates the regulation of individual health practitioners, not health services themselves. However, health practitioners are also expected to meet the requirements of other parts of the health system within which they operate, whether a local hospital, health authority, government department or statutory authority.

Above all else, the National Scheme is in place to protect patients. It builds consistent and local decision-making into national standards. This is supported by local AHPRA offices in each state and territory, which manage stakeholder engagement and work with boards and committees at a local level.

In 2016/17, the percentage of registrants in each state and territory remained relatively consistent with the previous year. As at 30 June 2017, of the total 678,938 registered health practitioners:

f 11,845 had a principal place of practice in the Australian Capital Territory (ACT)

f 196,605 in New South Wales (NSW) f 7,083 in the Northern Territory (NT) f 133,103 in Queensland (Qld) f 53,823 in South Australia (SA) f 14,522 in Tasmania (Tas) f 175,354 in Victoria (Vic), and f 69,012 in Western Australia (WA).

The National Scheme is unique internationally. It allows for a direct relationship with individual practitioners

through registration, national accountability and local decision-making, while supporting the transparency of a national Register of practitioners that anyone can check. It would not work without the involvement of local stakeholders who play a significant role in patient safety. This balance of national and local influences is what helps the National Scheme contribute to improvements to the wider healthcare system.

The national and regional strength of the National Scheme means that only suitably trained and qualified practitioners are registered. It also facilitates workforce mobility across Australia, the provision of high-quality education and training of health practitioners and rigorous assessment of overseas-trained practitioners.

The National Scheme’s published regulatory principles (see page 9) guide the actions and decision-making of the National Boards and AHPRA. They ensure their primary focus is on public protection while using the minimum regulatory force needed to manage any risk to the public.

AHPRA and the National Boards work with the community, the professions and other stakeholders in government, and the education and health sectors more widely, to keep improving what they do and to make sure their work is focused on their core role of protecting the public and facilitating access to health services.

For more information about the regulation of health practitioners in each state and territory, refer to the 2016/17 jurisdictional annual report summaries at www.ahpra.gov.au/annualreport/2017.

Figure 2: Percentage of practitioners with a principal place of practice in each state and territory1

1.7% in ACT

25.8% in Vic

2.1% in Tas

7.9% in SA

29% in NSW

19.6% in Qld

1% in NT

10.2% in WA

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AHPRA and the National Boards: working together to protect the public The National Boards work with the support of AHPRA to ensure safe, quality healthcare across Australia. Guided by the National Law, the boards make decisions about registrants who practise the 14 regulated health professions.

The National Boards protect the community by making sure that only those practitioners who are suitably trained and qualified are registered.

The Boards’ responsibilities include setting standards that practitioners must meet in order to be registered, making policy decisions, and investigating complaints and concerns raised about registered health practitioners.

Chairs and Presiding Members for each National Board in 2016/17 are listed below. Executive Officers, based in AHPRA’s National Office, offer executive support to each of the National Boards.

For more detailed information about any of the National Boards during the year, download their profession summary from www.ahpra.gov.au/annualreport/2017.

Mr Bruce Davis Presiding Member, Aboriginal and Torres Strait Islander Health Practice Board of Australia

Professor Charlie Xue Chair, Chinese Medicine Board of Australia

Dr Wayne Minter AM Chair, Chiropractic Board of Australia

Dr John Lockwood AM Chair, Dental Board of Australia

Dr Joanna Flynn AM Chair, Medical Board of Australia

Mr Mark Marcenko Chair, Medical Radiation Practice Board of Australia

Associate Professor Lynette Cusack RN Chair, Nursing and Midwifery Board of Australia

Ms Julie Brayshaw Chair, Occupational Therapy Board of Australia

Mr Ian Bluntish Chair, Optometry Board of Australia

Dr Nikole Grbin Chair, Osteopathy Board of Australia

Mr William Kelly Chair, Pharmacy Board of Australia

Dr Charles Flynn Chair, Physiotherapy Board of Australia

Ms Catherine Loughry Chair, Podiatry Board of Australia

Professor Brin Grenyer Chair, Psychology Board of Australia


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Aboriginal and Torres Strait Islander Health Practice Board of Australia in 2016/17

A snapshot of the profession

608 Aboriginal and Torres Strait Islander Health Practitioners 0.1% of total health practitioner registrant base

Up 3.6% from 2015/16

448 registered students (up 53.4% from last year)

7 notifications lodged with AHPRA about Aboriginal and Torres Strait Islander Health Practitioners

1.2% of Aboriginal and Torres Strait Islander Health Practitioners had notifications made about them

6 notifications closed this year33.3% resulted in accepting an undertaking or conditions being imposed on an Aboriginal and Torres Strait Islander Health Practitioner’s registration

16.7% resulted in an Aboriginal and Torres Strait Islander Health Practitioner receiving a caution or reprimand by the Board

50% resulted in no further action being taken

2 mandatory notifications were made; both were about standards of practice

9 Aboriginal and Torres Strait Islander Health Practitioners were monitored for health, performance and/or conduct during the year

72 cases were actively monitored (4 on the grounds of health, 3 for performance and 65 for suitability/eligibility for registration)

3 statutory offence complaints were made; 2 were closed2 of the new matters related to title protection

Key works of the BoardThe Aboriginal and Torres Strait Islander Health Practice Board of Australia (the Board) works in partnership with AHPRA to implement the National Scheme. Together, they are responsible for the registration and regulation of practitioners of this relatively new health profession, ensuring that only those practitioners who are suitably qualified and competent to practise are registered.

Among other requirements, to be eligible for registration, a practitioner must be an Aboriginal and/or Torres Strait Islander.

Awareness of the professionRegistrants in the Aboriginal and Torres Strait Islander Health Practice profession grew by 3.6% this year, which indicates an increasing awareness and appreciation of the value and importance of providing culturally appropriate healthcare to Aboriginal and Torres Strait Islander people.

The task of accrediting education providers for this profession is sometimes challenging given that many of our approved programs of study are delivered where they are required – in rural and remote areas. There are currently 12 programs of study that have been approved for this profession by the Board for the purposes of registration. Find them at www.ahpra.gov.au/Education/Approved-Programs-of-Study.

Stakeholder relationsThis year, the Board continued to engage with many stakeholders, particularly the National Aboriginal and Torres Strait Islander Health Worker Association, which includes not only Aboriginal Health Workers, but registered Aboriginal and Torres Strait Islander Health Practitioners as well.

The Board also played a leading role in the commencement of the development of a Reconciliation Action Plan for AHPRA and the National Boards. This is an important inclusion in a broader strategy: the National Scheme’s Aboriginal and Torres Strait Islander health strategy, which supports better health outcomes for Australia’s first peoples.

For more information about the Aboriginal and Torres Strait Islander Health Practice Board of Australia’s work in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.

http://www.ahpra.gov.au/Education/Approved-Programs-of-Studyhttp://www.ahpra.gov.au/Education/Approved-Programs-of-Studyhttp://www.ahpra.gov.au/annualreport/2017


Chinese Medicine Board of Australia in 2016/17


4,860 Chinese medicine practitioners0.7% of total health practitioner registrant base

Up 2.1% from 2015/16

1,515 registered students (up 14.9% from last year)

36 notifications lodged with AHPRA about Chinese medicine practitioners

1.2% of Chinese medicine practitioners had notifications made about them

34 notifications closed this year23.5% resulted in accepting an undertaking or conditions being imposed on a Chinese medicine practitioner’s registration

8.8% resulted in a Chinese medicine practitioner receiving a caution or reprimand by the Board

67.6% resulted in no further action being taken

Immediate action was taken once

24 Chinese medicine practitioners were monitored for health, performance and/or conduct during the year

945 cases were actively monitored (4 on the grounds of conduct, 8 for performance and 933 for suitability/eligibility for registration)

72 statutory offence complaints were made; 38 were closedOver half of new matters related to advertising breaches, and the majority of the remaining matters related to title protection

Key works of the Board

Engaging with the professionOne of the main focuses for the Chinese Medicine Board of Australia (the Board) during the year was to ensure practitioners were aware of their professional obligations as registered practitioners. A series of quick reference guides were published, which provide concise, clear information for practitioners about safe Chinese herbal medicine practice. Minor amendments were also made to the key resource, the Nomenclature compendium of commonly used Chinese herbal medicines.

Following wide consultation, the Board published new guidelines for creating and maintaining health records. It also released a Position statement on endangered species and Chinese medicine in Australia.

Preliminary consultation with key stakeholders was undertaken on draft revised registration standards. The Board is expecting to consult publicly on the revised standards in the latter half of 2017 and will publish updated information about the consultation process on the Board’s website.

International relationsA highlight for the Board this year was sending a delegation to China for the first time. The visit took place in May 2017, and was partially funded by a grant from the Australia-China Council. It presented a fantastic opportunity for the Board to engage with international regulatory counterparts. During the visit, social media updates were posted in both Chinese and English.

Listening to stakeholdersIn 2016/17, the Board established the Chinese Medicine Reference Group (CMRG), comprising individual practitioner members, community members, and representatives of professional associations and education institutions. The purpose of the group is to promote a common understanding of the National Scheme, and to have members of both the community and profession share thoughts and give advice on policy and other matters. The CMRG held its first meeting in February 2017.

Find out more about the initiatives mentioned above at www.chinesemedicineboard.gov.au. Refer to Appendix 5 to view standards, codes and guidelines that were approved during the year.

For more information about the Chinese Medicine Board of Australia’s work in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.

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Chiropractic Board of Australia in 2016/17


5,284 chiropractors0.8% of total health practitioner registrant base

Up 2.3% from 2015/16


103 notifications lodged with AHPRA about chiropractors

3.1% of chiropractors had notifications made about them

88 notifications closed this year14.8% resulted in accepting an undertaking or conditions being imposed on a chiropractor’s registration

26.1% resulted in a chiropractor receiving a caution or reprimand by the Board


Immediate action was taken 14 times

11 mandatory notifications were made (4 about standards, 2 about impairment and 5 about sexual misconduct)

45 chiropractors were monitored for health, performance and/or conduct during the year

49 cases were actively monitored (7 on the grounds of conduct, 2 for health reasons, 10 for performance, 6 prohibited practitioners/students and 24 for suitability/eligibility for registration)

162 statutory offence complaints were made; 192 were closed The overwhelming majority of new matters related to advertising breaches


Awareness-raising campaignsA focus for the year was providing practitioners with all the information they need to meet their obligations under the National Law. Part of this strategy included employing clear and concise communications to raise awareness within the profession about advertising requirements.

Misleading and deceptive advertising continued to be an issue for the profession in 2016/17. The Board maintained its strong position, and engaged closely with stakeholders on this issue. As a part of this work, AHPRA and the Board co-hosted a forum on advertising by chiropractors for a wide range of stakeholders, including professional bodies, community groups and representatives of AHPRA’s Community Reference Group. Working closely with AHPRA, the Board also developed helpful resources to assist chiropractors in better understanding what is, and is not, allowed.

A forum on professionalism in chiropractic care was co-hosted by the Board and the Council on Chiropractic Education Australasia (CCEA), for an audience of chiropractic educators and professional bodies. Workshops were held to advance the conversation on self-regulation of learning for practitioners, particularly about continuing professional development (CPD), remediation and/or return to practice.

The Board has embraced multi-media technology to support practitioners, including the online publication of vodcasts during the renewal period, which explained revised registration standards to help chiropractors better understand their registration requirements.

Advising on the professionMinisters called on the Board to provide advice on issues related to the potentially unsafe treatment of children and pregnant women. In addition to giving advice, the Board revised the following position statements, which were originally published in 2015: Statement on paediatric care and Statement on provision of health information (see www.chiropracticboard.gov.au/Codes-guidelines/FAQ/Position-statements). The Board has made it clear that chiropractors have a responsibility to practise in an evidence-based and patient-centred manner, and to recognise and work within the limits of their competence and scope of practice. Read the statements at www.chiropracticboard.gov.au/Codes-guidelines.

Enforcing the National LawAHPRA and the Board successfully took strong action against a number of chiropractors on matters ranging from misleading advertising to boundary violation and sexual misconduct this year. Outcomes of these matters are published at www.chiropracticboard.gov.au/News.

Refer to Appendix 5 to view revised standards that came into effect during the year.

For more information about the Chiropractic Board of Australia in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.

http://www.chiropracticboard.gov.au/Codes-guidelines/FAQ/Position-statementshttp://www.chiropracticboard.gov.au/Codes-guidelines/FAQ/Position-statementshttp://www.chiropracticboard.gov.au/Codes-guidelineshttp://www.chiropracticboard.gov.au/Newshttp://www.ahpra.gov.au/annualreport/2017


Dental Board of Australia in 2016/17


22,383 dental practitioners3.3% of total health practitioner registrant base

Up 3% from 2015/16

4,736 registered students (down 1.5% from last year)

526 notifications lodged with AHPRA about dental practitioners3.8% of dental practitioners had notifications made about them

One notification was made about a student

485 notifications closed this year14.6% resulted in accepting an undertaking or conditions being imposed on a dental practitioner’s registration

20% resulted in a dental practitioner receiving a caution or reprimand by the Board

0.8% resulted in suspension or cancellation of registration



21 mandatory notifications were made (19 about standards, one about impairment and one about sexual misconduct)

199 dental practitioners were monitored for health, performance and/or conduct during the year

134 cases were actively monitored (14 on the grounds of conduct, 16 for health reasons, 64 for performance, 5 prohibited practitioners/students and 35 for suitability/eligibility for registration)

239 statutory offence complaints were made; 295 were closed The overwhelming majority of new matters related to advertising breaches

Key works of the BoardThis year, the Dental Board of Australia (the Board) submitted a proposed revised List of recognised dental specialties, related specialist titles and definitions for approval to the AHWMC. Though minor, these changes will align specialist titles and/or definitions with international nomenclature and better reflect the nature of work undertaken by dentists within their existing specialty.

Also in 2016/17, entry-level competencies were published on the Board website, which detail the expectations of applicants for endorsement of registration in the conscious sedation area of practice. It re-approved seven programs to extend scope of practice until 31 December 2018. The Board also reviewed the approval process of these programs and has agreed to phase out the approval of these programs.

Overseas specialist qualificationsAt the start of this year, the Board commenced the assessment of all applications from overseas specialist qualifications for substantial equivalence to Australian specialist programs.

In support of these arrangements, the Board, with AHPRA, implemented a new process to assess overseas specialist qualifications for substantial equivalence to Australian specialist programs.

As part of its work program on specialist registration pathways for overseas trained dental specialists, the Board engaged the Australian Dental Council (ADC) to develop an outcome-based assessment model for overseas-trained dental specialists applying for specialist registration in Australia. The Board will utilise its Expert Reference Group – Specialists to act as liaison with the ADC to help progress the project.

Awareness-raising campaignsIn 2016/17, the Board took a new, multimedia approach to the way it communicates with the profession and the public. This culminated in the launch of two videos to raise awareness of, and for, the profession at www.dentalboard.gov.au:

f Tips for patients gives dental patients easy-to-remember ways to tell whether their dental practitioner is following the correct infection-control protocols.

f Overview of your obligations as a registered dental practitioner highlights some of the key requirements for dental practitioners to maintain registration and provides guidance about expected behaviours.

At the end of the financial year, a third video was in production, which will provide registration information for graduates of dental study.

Refer to Appendix 5 to view standards that came into effect during the year.

For more information about the Dental Board of Australia in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.

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Medical Board of Australia in 2016/17


111,166 medical practitioners16.4% of total health practitioner registrant base

Up 3.7% from 2015/16


3,617 notifications lodged with AHPRA about medical practitioners5.1% of medical practitioners had notifications made about them

2 notifications were made about students

3,557 notifications closed this year7.3% resulted in accepting an undertaking or conditions being imposed on a medical practitioner’s registration

11% resulted in a medical practitioner receiving a caution or reprimand by the Board



Most of the remaining 4.7% were retained by a health complaints entity

Immediate action was taken 102 times; 23 resulted in suspension of registration

224 mandatory notifications were made (161 about standards, 41 about impairment, 5 about alcohol or drugs, and 17 about sexual misconduct)

1,000 medical practitioners were monitored for health, performance and/or conduct during the year

1,620 cases were actively monitored (126 on the grounds of conduct, 216 for health reasons, 213 for performance, 55 prohibited practitioners/students, and 1,010 for suitability/eligibility for registration)

273 statutory offence complaints were made; 283 were closed Over half of the new matters related to advertising breaches, and the majority of the remaining matters related to title protection


RevalidationThe Medical Board of Australia (the Board) is committed to developing a process that supports medical practitioners to maintain and enhance their professional skills and knowledge, and to remain fit to practise medicine. The term ‘revalidation’ has been used for this process. In 2015/16, the Board appointed an Expert Advisory Group (EAG) to advise it on options for revalidation. During 2016/17, the EAG delivered their interim report, which identified a two-part approach:

f maintaining and enhancing the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based continuing professional development relevant to their scope of practice, and

f proactively identifying doctors at risk of poor performance and those who are already performing poorly, assessing their performance and, when appropriate, supporting remediation of their practice.

The Board consulted on the proposal in the interim report over a four-month period. The EAG has been analysing feedback and is scheduled to deliver its report in 2017/18.

Social researchIn 2016/17, the Board commissioned independent social research, related to its work on revalidation, to better understand what the public expects doctors to do to demonstrate ongoing fitness and competence, and what medical practitioners believe they need to do to maintain and enhance their knowledge and skills.

The research analysed feedback from 3,000 doctors and 1,000 members of the community. Key findings were:

f 90% of the community trust doctors and nurses, 85% trust pharmacists and 7% trust politicians.

f Doctors and the community agree that the most important attributes for building confidence and trust with patients are effective communication and doctors explaining their diagnosis and treatment.

f 39% of doctors and 72% of the public think doctors’ practice should be reviewed at least every five years.

f 40% of doctors and 5% of the public think doctors should only be reviewed if there are concerns about their practice.

f More than half the doctors surveyed support demonstrating their capacity to provide high-quality medical care as a requirement of their annual registration renewal.

(Continued on next page)


12th International Conference on Medical Regulation The Board and AHPRA co-hosted this conference in Melbourne in September 2016. More than 490 participants from more than 40 countries gathered, with the aim of making a difference to patient safety through regulation. Watch a wrap-up video at www.medicalboard.gov.au/News/IAMRA-2016.

Doctors’ health advisory and referral servicesFrom 2016/17, doctors and medical students in all states and territories were able to access help and support through the expanded network of doctors’ health advisory and referral services.

The national network of services is coordinated by Doctors’ Health Services Pty Ltd, a wholly owned subsidiary of the Australian Medical Association (AMA), and funded by the Medical Board of Australia.

The Board has significantly boosted resources to doctors’ health, sourced from within existing Board funds from registration fees paid by medical practitioners. The partnership with the AMA enables the health programs to be administered at arm’s length from the Board and AHPRA. See www.doctorportal.com.au/doctorshealth.

Taking action on bullying and harassmentBullying and harassment are serious problems in the medical profession and have a direct impact on patient safety. Setting clear standards and holding doctors to account against them is the job of regulators. Getting clear about the roles and responsibilities of colleges, employers and regulators in dealing with these problems so that everyone knows what the standard is, and what to do if someone fails to meet it is one of the things we will do with others.

The Board committed to taking action on bullying and harassment by:

f strengthening the Board’s Good medical practice – a code of conduct for doctors in Australia about bullying and harassment and making the standards of acceptable behaviour for doctors clear

f taking the lead in developing and implementing a national, annual survey of trainees, which will give them a voice, be a safe place for them to provide feedback on their training experience and enable systemic issues such as potential hotspots of bullying and harassment to be identified. AHPRA and the Board will work with health departments, employers, medical colleges, and the Australian Medical Council to develop the governance and funding arrangements to make this happen

f commissioning research on vexatious complaints to understand how and why people are driven to make them, and what we can do about it. The data we have now indicate this is a small problem with a big impact when it happens. We will publish what we learn and act on it, and

f strengthening Good medical practice – a code of conduct for doctors in Australia on vexatious complaints and establishing a clear benchmark to enable the Board to take further action about a medical practitioner who makes complaints purely to damage another registered practitioner.

Independent review of the use of chaperonesIn August 2016, the Board and AHPRA commissioned the Independent review of the use of chaperones to protect patients in Australia. The reviewer, Professor Ron Paterson, was asked to consider whether, and if so in what circumstances, it is appropriate to impose a chaperone condition on the registration of a health practitioner to protect patients while allegations of sexual misconduct are investigated.

The reviewer was also asked to recommend whether changes to regulatory practice, and the National Law, are needed to better protect patients and the public.

The report recommended three areas for regulatory reform:

f No longer using chaperones as an interim restriction while allegations of sexual misconduct are investigated

f Establishing a specialist team within AHPRA working with the MBA to improve our handling of sexual misconduct complaints, and

f Strengthening monitoring and providing more information to patients in the exceptional cases when chaperone conditions are in place.

The report recommended a number of areas for regulatory reform, and AHPRA and the Board accepted all of them. Read more at www.medicalboard.gov.au/News/2017-04-11-chaperone-report.

Review of specialist collegesAnother important piece of work commissioned by the Board this year was a review of specialist college performance in relation to the assessment of specialist international medical graduates. This work arose from a recommendation in the independent review of the National Registration and Accreditation Scheme that was accepted by Health Ministers. The Board appointed Deloitte Access Economics, who will seek input from external stakeholders including specialist international medical graduates (IMGs) and employers. The review will continue throughout 2017 and the Board will consider the report in early 2018.

Refer to Appendix 5 to view guidelines and registration standards that were approved and/or came into effect during the year.

For more information about the Medical Board of Australia in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.

http://www.medicalboard.gov.au/News/IAMRA-2016http://www.medicalboard.gov.au/News/IAMRA-2016http://www.doctorportal.com.au/doctorshealthhttp://www.medicalboard.gov.au/News/2017-04-11-chaperone-reporthttp://www.medicalboard.gov.au/News/2017-04-11-chaperone-reporthttp://www.ahpra.gov.au/annualreport/2017

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Medical Radiation Practice Board of Australia in 2016/17


15,683 medical radiation practitioners2.3% of total health practitioner registrant base

Up 2.5% from 2015/16

3,895 registered students (up 13% from last year)

23 notifications lodged with AHPRA about medical radiation practitioners

0.3% of medical radiation practitioners had notifications made about them during the year

29 notifications closed this year17.2% resulted in accepting an undertaking or conditions being imposed on a medical radiation practitioner’s registration

20.7% resulted in a medical radiation practitioner receiving a caution or reprimand by the Board


Immediate action was taken twice

6 mandatory notifications were made (4 about standards, one about impairment, and one about drugs or alcohol)

17 medical radiation practitioners were monitored for health, performance and/or conduct during the year

88 cases were actively monitored (4 for health reasons, 3 for performance, one prohibited practitioners/students, and 80 for suitability/eligibility for registration)

4 statutory offence complaints were made; 9 were closed3 of the new matters related to title protection, and one matter related to advertising breaches


Awareness-raising campaignsIn 2016/17, the Medical Radiation Practice Board of Australia (the Board) began a strategic communications drive that included publishing short information pieces in its newsletters to raise awareness of important considerations that will reduce the risk of harm to the public. The first in the series focused on radiation safety in paediatric imaging, while in June 2017 the Board published information on the importance of handwashing.

Using radiation safely is an essential element of good medical radiation practice. With the greater proportion of registered medical radiation practitioners using radiation in their daily practice, the potential for radiation-induced harm is always at the forefront of decision-making in clinical practice.

The Board also developed material that supports Australia’s celebration of World Radiographer Day, which is an internationally recognised day that aims to build greater awareness of the value that medical radiation practitioners add to safe patient care.

Scope of practiceScope of practice across three divisions of registration has also been an ongoing focus for the Board. Information was developed to assist practitioners in understanding the minimum requirements for practice.

The three divisions are: f diagnostic radiographers f radiation therapists, and f nuclear medicine technologists.

The communications to practitioners around this included how they might expand their scope of practice through education and clinical training.

The Professional capabilities for medical radiation practice identifies that a significant part of medical radiation practice is common across all three divisions. Changing technology and the blending of practice areas demonstrate the need for an adaptable and flexible skill set for registered practitioners. The changes pose fundamental questions for the Board as a profession regulator. Equally, they challenge the traditional view of medical radiation practice. More work on scope of practice will continue in 2017/18.

Refer to Appendix 5 to view standards and guidelines that were approved or came into effect during the year.

For more information about the Medical Radiation Practice Board of Australia in 2016/17, download the profession summary report from www.ahpra.gov.au/annualreport/2017.



Nursing and Midwifery Board of Australia in 2016/17


Nursing

386,629 nurses56.9% of total health practitioner registrant base

Up 2.8% from 2015/16

Of the 386,629 nurses, 28,928 also hold registration in midwifery

The number of dual registered nurses and midwives is down 2.6% from last year


1,568 notifications lodged with AHPRA about nurses0.6% of nurses had notifications made about them

24 notifications were made about nursing students

1,473 notifications closed this year22.7% of matters resulted in accepting an undertaking or conditions being imposed on a nurse’s registration

16.4% resulted in a nurse receiving a caution or reprimand by the Board


57% resulted in no further action being taken


471 mandatory notifications were made (338 about standards, 88 about impairment, 26 about alcohol or drugs, and 19 about sexual misconduct)

1,233 nurses were monitored for health, performance and/or conduct during the year

1,553 cases about nurses were actively monitored (116 on the grounds of conduct, 288 for health reasons, 164 for performance, 158 prohibited practitioners/students, and 827 for suitability/eligibility for registration)

76 statutory offence complaints were made; 80 were closedThe majority of new matters related to title protection


Midwifery

33,552 midwives4.9% of total health practitioner registrant base

Down 0.8% from 2015/16

Of the 33,552 midwives, 4,624 hold registration as a midwife only (up 12.2% from last year)


75 notifications lodged with AHPRA about midwives

0.3% of midwives had notifications made about them

86 notifications closed this year22.1% of matters resulted in accepting an undertaking or conditions being imposed on a midwife’s registration

26.7% resulted in a midwife receiving a caution or reprimand by the Board



Immediate action was taken twice

17 mandatory notifications were made (14 about standards and 3 about impairment)

52 midwives were monitored for health, performance and/or conduct during the year

155 cases about midwives were actively monitored (6 on the grounds of conduct, 3 for health reasons, 10 for performance, 3 prohibited practitioners/students and 133 for suitability/eligibility for registration)

8 statutory offence complaints were made; 35 were closed6 of the new matters related to title protection and 2 related to advertising breaches

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The launch of a national support service for nurses and midwivesThe Nursing and Midwifery Board of Australia (NMBA) launched Australia’s first national health support service for nurses and midwives on 8 March 2017. Nurse & Midwife Support offers a 24-hour telephone service as well as online support, providing advice and referral on health issues for Australia’s nurses, midwives and nursing and midwifery students.

The service is an NMBA initiative that supports nurses and midwives with health issues in order to contribute to safe care for the public. It was developed following NMBA-commissioned research into the role a regulator might play in supporting national health programs in relation to health impairment under the National Law.

Nurse & Midwife Support is run independently by Turning Point, a leading health treatment, research and education organisation in Australia. See www.nmsupport.org.au.

Partnerships, collaboration and consistencyThe NMBA hosted its national conference in March, bringing together members of the national, state and territory boards, AHPRA staff and key regulatory partners such as the HPCA, the Midwifery Council of New Zealand and the Nursing Council of New Zealand.

The conference theme was Partnerships, collaboration and consistency, with the aim of better experiences and outcomes in the regulation of nurses and midwives across Australia.

Public consultation on revised codes of conductThe NMBA opened public consultation in January 2017 on the revised Code of conduct for nurses and Code of conduct for midwives (the codes).

The codes are important documents that set out the legal requirements, professional behaviour and conduct expectations for nurses and midwives in all practice settings. The codes describe the principles of professional behaviour that guide safe practice, and clearly outline the conduct expected of nurses and midwives by their colleagues and the broader community.

The draft revised codes were developed by the NMBA through extensive consultation with key stakeholders and the nursing and midwifery professions, as well as literature and evidence reviews.

The consultation had 3,000 responses and this feedback was incorporated into the final codes, which will be released later in 2017 to take effect in 2018.

Midwife standards for practiceDeakin University was appointed in June 2016 to develop the NMBA’s Midwife standards for practice, including a review of the existing National competency standards for the midwife (2006).

The current National competency standards for the midwife are the core competency standards by which a midwife’s performance is assessed to obtain and retain registration to practise in Australia. Since these standards were published in 2006, the role and scope of practice for midwifery throughout Australia, the model of education and training, and the regulatory framework within which registration of midwives occurs, have developed substantially.

Throughout the year, Deakin University undertook research and analysis on behalf of the NMBA to draft the new Midwife standards for practice to be suitable for midwives in all contexts of practice. Research included literature reviews, observations of midwives in practice, preliminary consultation with key stakeholders, and workshops with an expert advisory group.

The Midwife standards for practice are expected to be released in

Documents

For safer healthcare - Parliament of Victoria...AHPRA on social media in 2016/17 9,501 views of our videos on YouTube, with over 12,991 minutes watched We received and responded to